Chronic use of immunosuppressive medications does not worsen coronavirus disease 2019 (COVID-19) outcomes for hospitalized patients, according to study results published in Clinical Infectious Diseases.
In this retrospective study, researchers analyzed data from 2121 hospitalized patients (median age, 55 years) with COVID-19 seen at the Johns Hopkins University School of Medicine, Baltimore, Maryland, to determine if there was a difference in risk of mechanical ventilation, length of hospital stay, or in-hospital mortality among individuals with and without chronic use of immunosuppressive medications.
Of the 2121 patients, only 5% (n=108) used immunosuppressing medications before COVID-19, primarily prednisone greater than 7.5 mg, tacrolimus, or mycophenolate mofetil.
In the unadjusted analysis, all 3 outcomes were similar between individuals with and without chronic use of immunosuppressive medications. The proportion of individuals undergoing mechanical ventilation was 16% (n=17) in those who used immunosuppressive medications vs 15% (n=294) in those who did not (P =.75).
Likewise, the median length of hospital stay was not statistically significant between those who did and did not use immunosuppressive medications (6.9 days vs 5.1 days; P =.09). For in-hospital mortality, neither the proportion (7% vs 7%; P =.73) nor the median time to death (27.2 days vs 13.3 days; P =.25) was significantly different between patients who were immunosuppressed and immunocompetent.
When researchers controlled for confounding using an inverse probability of treatment weighting approach, there continued to be no statistically significant difference in all 3 outcomes between the 2 groups:
- Mechanical ventilation: hazard ratio [HR], 0.79; 95% CI, 0.46-1.35
- Length of hospital stay: HR, 1.16; 95% CI, 0.92-1.47
- In-hospital mortality: HR, 0.66; 95% CI, 0.28-1.55
Results remained similar using propensity score matching and propensity score adjustment.
Furthermore, sensitivity analyses with varying exposure and outcome definitions showed consistent results.
The small sample size was a key limitation to this study. “Further work is needed to examine the association between chronic immunosuppression and longer-term morbidity and mortality,” the researchers noted.
Disclosure: Two study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Andersen KM, Mehta HB, Palamuttam N, et al. Association between chronic use of immunosuppresive drugs and clinical outcomes from coronavirus disease 2019 (COVID-19) hospitalization: a retrospective cohort study in a large US health system. Clin Infect Dis. Published online January 7, 2021. doi:10.1093/cid/ciaa1488